Clinical Pharmacist Advisor (Medicare Part D) – REMOTE

Clinical Pharmacist Advisor (Medicare Part D) – Remote | $53/hour

We are seeking a highly experienced Clinical Pharmacist Advisor to support Medicare Part D operations in a fully remote environment. This role is ideal for pharmacists with a strong background in PBM (Pharmacy Benefit Management), Managed Care, Health Plan operations, and Prior Authorization determinations.

This is a high-impact opportunity to work in a structured, performance-driven setting with the potential for long-term career growth.

Schedule & Training
• Training: Monday – Friday, 9:00 AM – 5:30 PM EST (first 8 weeks, mandatory, no time off)
• Work Hours: Rotating shifts within:
• Monday – Friday: 7:00 AM – 8:00 PM EST
• Saturday & Sunday: 7:00 AM – 4:30 PM EST
• Must be flexible to work assigned shifts, including weekends

Compensation
• Pay Rate: $53.00 per hour
• Opportunity for full-time conversion based on performance

Work Environment & Requirements
• 100% Remote (Work From Home)
• Dedicated, quiet workspace required
• Wired internet connection required (minimum 25 Mbps download / 5 Mbps upload)
• Must provide internet speed test screenshot with application
• Must provide active pharmacist license screenshot (showing name, state, and validity dates)

Job Overview

In this role, you will review and process Medicare Part D requests, including prior authorizations and appeals, ensuring accurate clinical decision-making and strict compliance with CMS guidelines. You will collaborate with providers, analyze clinical data, and deliver timely, high-quality outcomes that directly impact patient care.

Key Responsibilities
• Review and evaluate Medicare Part D prior authorization requests and appeals
• Accurately set up and document cases within internal systems
• Apply clinical judgment using drug compendia and CMS Medicare guidelines
• Conduct outreach to providers to obtain additional clinical information as needed
• Ensure compliance with CMS regulations, timelines, and internal quality standards
• Maintain clear, accurate, and detailed documentation
• Meet productivity and quality expectations in a fast-paced environment
• Participate in feedback and performance development discussions

Required Qualifications (Must-Have)
• Active Pharmacist license in good standing in state of residence
• PharmD or Bachelor’s degree in Pharmacy
• REQUIRED: Prior experience in PBM, Managed Care, or Health Plan environment
• REQUIRED: Direct experience with Prior Authorization and/or coverage determination reviews
• Strong clinical decision-making and analytical skills
• Experience with data entry and navigating multiple systems simultaneously
• Ability to work independently in a remote, productivity-driven role

Preferred Qualifications
• Medicare Part D experience
• Appeals and coverage determination experience
• Proficiency with Microsoft Excel, Word, Access, PowerPoint, and Visio

Important Requirements:
• Camera must be on for training and team meetings
• Position is safety-sensitive
• Must be able to sit and remain focused for the duration of scheduled shifts

Candidate Expectations
• Strong attendance is critical, especially during the first 8–10 weeks of training
• Ability to manage multiple systems and perform high-volume data entry
• Comfortable making outbound calls to providers when needed
• Positive, engaged, and team-oriented mindset

Why Apply?

This role offers experienced pharmacists the opportunity to leverage their managed care and prior authorization expertise in a remote setting while supporting Medicare members and providers. You will gain valuable experience in clinical review, compliance, and pharmacy benefit operations, with strong potential for long-term career advancement.

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